9930 EVERGREEN WAY LAKESIDE MILAM RECOVERY 2017-05-23

ELECTRICAL PERMIT AOOLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION ID PROJECT ADDRESS: j� BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL EUSEF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES �rNO ASSOCIATED BUILDING PERMIT# if applicable DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: TENANT NAME If Commercial): `1A)jjW OWNER MAILING ADDRESS: STREET F:D OJEArnyten N SU ITE t O" CITY�, &JU14 STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET Q® CITY epn� STATE ZIP < CONTRACTOR PHONE: 2-b LP- - ' CONTRACTOR EMAIL:SL� �} C�MZ�1 (�(r. CONTRACTOR LIC.#(REQUIRED): * 050)3s CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5� PRIMARY CONTACT: ❑ OWNER 51CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2-0 CONTACT EMAIL: j e?_— JNA AGREEMENT,'T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE �.00 PERMIT# DiW r/Authorized Agent Signature Date (Revised 10/12/2015)